[1]王大佳,张志波,白玉作,等.先天性腹壁缺损性疾病产时手术的疗效与安全性研究[J].临床小儿外科杂志,2022,21(09):833-837.[doi:10.3760/cma.j.cn101785-202206003-007]
　Wang Dajia,Zhang Zhibo,Bai Yuzuo,et al.Comparison of intrapartum versus non-intrapartum operations for congenital abdominal wall defects[J].Journal of Clinical Pediatric Surgery,2022,21(09):833-837.[doi:10.3760/cma.j.cn101785-202206003-007]
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先天性腹壁缺损性疾病产时手术的疗效与安全性研究

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第21卷 期数: 2022年09期 页码: 833-837 栏目: 专题·出生结构缺陷的早期干预 出版日期: 2022-09-28
Title:
Comparison of intrapartum versus non-intrapartum operations for congenital abdominal wall defects
作者:
王大佳1;  张志波1;  白玉作2;  刘彩霞3
1. 中国医科大学附属盛京医院新生儿外科, 沈阳 110004;
2. 中国医科大学附属盛京医院小儿普外科, 沈阳 110004;
3. 中国医科大学附属盛京医院产科, 沈阳 110004
Author(s):
Wang Dajia1;  Zhang Zhibo1;  Bai Yuzuo2;  Liu Caixia3
1. Department of Neonatal Surgery, Affiliated Shengjing Hospital, Shenyang 110004, China;
2. Department of Pediatric General Surgery, Affiliated Shengjing Hospital, Shenyang 110004, China;
3. Department of Obstetrics, Affiliated Shengjing Hospital, China Medical University, Shenyang 110004, China
关键词:
婴儿; 新生; 腹壁/外科学; 胎儿期疗法
Keywords:
Infant;  Newborn; Abdominal Wall/SU; Fetal Therapies
DOI:
10.3760/cma.j.cn101785-202206003-007
摘要:
目的 探讨先天性腹壁缺损性疾病患儿产时手术的安全性与疗效。方法 回顾性分析2009年1月至2021年12月中国医科大学附属盛京医院收治的70例先天性腹壁缺损患儿临床资料，包括腹裂12例，脐膨出58例；其中产时手术34例（为产时手术组），非产时手术36例（为非产时手术组）。比较两组分期手术情况、应用补片、输血与外源输血、呼吸机使用情况、切口感染、低血糖、肝功能损伤、中心静脉相关感染、抗生素使用、静脉营养时间、进奶时间、住院时间、治疗结果以及术后随访情况。结果 产时手术组无一例外源性输血，非产时手术组8例外源性输血，差异有统计学意义（P<0.05）。产时手术组分期手术3例，非产时手术组分期手术1例，差异无统计学意义（P=0.28）。两组各有1例应用补片修补，差异无统计学意义（P=1.00）。术后切口感染：产时手术组1例，非产时手术组4例，差异无统计学意义（P=0.18）。术后肝功能损伤：产时手术组1例，非产时手术组4例，差异无统计学意义（P=0.18）。产时手术组无一例中心静脉相关感染，非产时手术组有2例发生中心静脉相关感染，差异无统计学意义（P=0.49）。两组呼吸机支持人数比例、全肠外营养（total parenteral nutrition，TPN）时间、开奶时间、抗生素使用时间及住院时间差异均无统计学意义（P>0.05）。产时手术组有1例患儿放弃治疗，治愈率97.06%（33/34）；非产时手术组1例死于呼吸衰竭，治愈率97.22%（35/36）；差异无统计学意义（P>0.05）。随访6个月至13年，两组患儿身高、体重均在同龄儿童2个标准差之内，神经系统发育基本正常，无一例因肠梗阻再手术。结论 产时手术和非产时手术治疗先天性腹壁缺损性疾病均安全、有效。产时手术患儿无需外源性输血，可避免异体输血相关风险。
Abstract:
Objective To compare the safety and efficacy of intrapartum operation with those of non-intrapartum operation in neonates with congenital abdominal wall defects.Methods From January 2009 to December 2021, clinical data were retrospectively for 70 neonates with congenital abdominal wall defects.There were gastroschisis (n=12) and omphalocele (n=58).Intrapartum (n=34) and non-intrapartum (n=36) operations were performed.Staging operation, mesh application, blood transfusion, exogenous blood transfusion, ventilator use, incision infection, hypoglycemia, liver damage, central vein-related infection, antibiotic use, intravenous nutrition time, feeding time, length of hospital stay, recovery and postoperative follow-ups were compared between two groups.Results There were zero and eight cases of exogenous transfusion in intrapartum and non-intrapartum operation groups (P < 0.05).Umbilical cord blood transfusion was performed in intrapartum operation group (n=4, P=0.25).And there were three and one case of staging operation in intrapartum and non-intrapartum operation groups (P=0.28).Patch repair was performed (n=1 each, P=1.00).Postoperative incision infection occurred in one and four cases in intrapartum and non-intrapartum operation groups (P=0.18) and the difference was not statistically significant.There were zero and two cases with central vein-related infection in intrapartum and non-intrapartum operation groups (P=0.49) and the difference was not statistically significant.No significant inter-group differences existed in ventilator support, TPN time, milk opening time, antibiotic use or hospital stay.Intrapartum operation group had a curative rate of 97.06% (one neonate withdrawing from the hospital) and non-intrapartum operation group had a curative rate of 97.22% (one neonate death due to respiratory failure); the difference was not statistically significant.Follow-up results showed that height and weight in two groups were within two standard deviations of each other for children of the same age.The development of nervous system was normal and there was no case of reoperation for intestinal obstruction.Conclusion Intrapartum and non-intrapartum operations are equally safe and effective for treating congenital abdominal wall defects.Neonates undergoing intrapartum operation do not need exogenous blood transfusion to avoid risks associated with allogeneic blood transfusion.

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备注/Memo

收稿日期:2022-06-30。
基金项目:辽宁省重点研发计划联合计划（2020JH2/10300131）；辽宁省兴辽英才计划（XLYC1908008）
通讯作者:张志波,E-mail:zhangzb@sj-hospital.org

更新日期/Last Update: 1900-01-01